Association Between Knee Pain, Impaired Function, and Development of Depressive Symptoms

Evaluation of Dynamic Effects of Depressive Symptoms on Physical Function in Knee Osteoarthritis

OBJECTIVE

To assess how changes in depressive symptoms influence physical function over time among those with radiographic knee osteoarthritis (OA).

METHODS

Participants from the Osteoarthritis Initiative with radiographic knee OA (n = 2,212) and complete data were identified at baseline. Depressive symptoms were assessed as a time-varying score at baseline and the first three annual follow-up visits using the Center for Epidemiological Studies Depression Scale (CES-D) Scale. Physical function was measured at the first four follow-up visits using 20-meter gait speed meters per second. The following two marginal structural models were fit: one assessing the main effect of depressive symptoms on gait speed and another assessing time-specific associations.

RESULTS

Time-adjusted results indicated that higher CES-D scores were significantly associated with slower gait speed (-0.0048; 95% confidence interval -0.0082 to -0.0014), and time-specific associations of CES-D were largest during the first follow-up interval (-0.0082; 95% confidence interval -0.0128 to -0.0035). During subsequent follow-up time points, the influence of depressive symptoms on gait speed diminished.

CONCLUSION

The negative effect of depressive symptoms on physical function may decrease over time as knee OA progresses.

Incidence of depression among community-dwelling older adults: A systematic review

We aimed to synthesise information related to the incidence of depression and depressive symptoms (DDS) in a community-dwelling older adult population at a global level. In this systematic review, we included articles with a cohort study design that evaluated the incidence of depression or depressive symptoms in older adults aged 60 years or more in a community-dwelling environment. Six databases were used: Web of Science, PubMed, Scopus, LILACS, SciELO, and Cochrane, and the entire selection process was independently performed by peers. We divided the included articles into subgroups according to the DDS assessment instrument: (i) Geriatric Depression Scale; (ii) Center for Epidemiologic Studies Depression Scale; (iii) miscellaneous scales; and (iv) diagnostic interviews. Each cumulative incidence value obtained per item was adjusted for a 1-year follow-up period, which generated an annual cumulative incidence (AcI). From 46 articles, 42 used scales to evaluate the depressive variable, with an AcI estimate of around 4.5%. The articles that assessed depression categorically observed a variation in AcI between 0.2% and 7.0%. Among all the materials included, the group that used the Geriatric Depression Scale observed the lowest and the highest AcI, 1.3% and 26.6% respectively. Most of the productions were from countries in the Asian continent (52.2%), followed by Europe (30.4%), the Americas (13%), and Oceania (4.4%). Despite the variation of AcI, we found a frequent occurrence of DDS in older adults in the community-dwelling environment, which highlights the need for preventive actions and better-targeted early care, especially in terms of primary health care.

Bidirectional causal relationship between psychiatric disorders and osteoarthritis: A univariate and multivariate Mendelian randomization study

BACKGROUND

Observational studies have shown associations between psychiatric disorders and osteoarthritis (OA). However, the causal impact of different psychiatric disorder types on specific sites of osteoarthritis remains unclear. This study aimed to comprehensively understand the potential causal associations between psychiatric disorders and osteoarthritis using Mendelian randomization (MR) analysis.

METHODS

We collected data from genome-wide association studies of knee osteoarthritis (KOA) (n = 403,124), hip osteoarthritis (HOA) (n = 393,873), osteoarthritis of the knee or hip (KHOA) (n = 417,596), as well as three psychiatric disorders: bipolar disorder (n = 41,917), major depressive disorder (n = 170,756), and schizophrenia (n = 76,755) among European populations. We applied bidirectional univariate and multivariate MR analyses, including inverse variance weighted, Mendelian randomization-Egger, weighted median, simple mode, and weighted mode. We considered p < .05 as a criterion for identifying potential evidence of association. Bonferroni correction was used for multiple tests.

RESULTS

Our univariate MR analysis results demonstrated that bipolar disorder is a protective factor for KOA (OR = 0.90, 95% CI = 0.83 to 0.97, p = 0.0048) and may also be protective for KHOA (p = 0.02). Conversely, major depression has a positive causal effect on both KOA (OR = 1.27; 95% CI = 1.08 to 1.49; p = 0.0036) and KHOA (OR = 1.24; 95% CI = 1.12 to 1.37; p = 3.62×10-05 ). Furthermore, our analysis suggested that KHOA may be a risk factor for major depression (OR = 1.06; 95% CI = 1.00 to 1.12; p = 0.0469) in reverse MR. After adjusting smoking (OR = 1.46; 95% CI = 1.19 to 1.65; p = 0.0032) and body mass index (OR = 1.44; 95% CI = 1.09 to 1.81; p = 8.56×10-04 ), the casual association between major depression and KHOA remained.

CONCLUSION

Our study indicates that major depression is a great risk factor for KHOA, increasing the likelihood of their occurrence. However, further in-depth studies will be required to validate these results and elucidate the underlying molecular mechanisms.

Factors Associated with Osteoarthritis and Their Influence on Health-Related Quality of Life in Older Adults with Osteoarthritis: A Study Based on the 2020 Korea National Health and Nutrition Examination Survey

Numerous studies have investigated factors associated with osteoarthritis (OA), but few have investigated their effects on psychological problems and health-related quality of life in older adults with OA. We aimed to investigate factors associated with OA and their influence on health-related quality of life in older adults with OA. Among 1394 participants aged ≥65 years, 952 and 442 were categorized into the OA and non-OA groups, respectively. Comprehensive data on demographic characteristics, medical conditions, health-related quality of life, blood test results, and nutritional intake were obtained. Univariate and multivariate logistic regression analyses were used to evaluate the odds ratio for factors associated with OA, including age (odds ratio (OR), 1.038; p = 0.020), female sex (OR, 5.692; p < 0.001), body mass index (OR, 1.108; p < 0.001), hypertension (OR, 1.451; p < 0.050), hyperlipidemia (OR, 1.725; p = 0.001), osteoporosis (OR, 2.451; p < 0.001), and depression (OR, 2.358; p = 0.041). The OA group showed a significantly lower subjective health status (p < 0.001) and higher difficulty in mobility (p < 0.001) and pain/discomfort (p = 0.010) than the non-OA group. The sleeping hours were significantly shorter in the OA group than those in the non-OA group (p = 0.013). OA was a significant contributing factor for unfavorable health-related quality of life in older adults. Controlling the factors associated with OA should be prioritized, and health-related quality of life should be monitored in older adults with OA.

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

Depression in Osteoarthritis: Current Understanding

Depression, one of the most common comorbidities with osteoarthritis (OA), affects patient prognosis and quality of life. It also increases the overall burden of disease. This subgroup of patients has not been effectively managed in clinical settings. The study aimed to direct physicians' attention to the co-occurrence of depression and OA. Therefore, this review summarizes the relevant literature published over the past 10 years. The focus is on the prevalence of and risk factors for depression in OA, the effects of depression on OA development and treatment response, comorbidity mechanisms, screening, and non-pharmacological treatment. The research on the etiology of depression has been driven largely by epidemiological studies. Recent studies have shown that high levels of pain, poor levels of function, high numbers of OA sites, and slow gait might be associated with depression. However, the pathophysiology of OA and depression comorbidities remains unclear. In addition to immune inflammation and structural changes in the brain, which have been documented in brain imaging studies, psychosocial factors may also play a role. The evidence indicates that depression can be treated with early intervention; however, adjustments may need to be made for individuals with comorbid depression in OA. It is recommended that health care providers pay more attention to depressive symptoms in patients with OA. Clinicians should develop and implement an individualized and comprehensive treatment plan for patients based on a mental health assessment and in teams with other professionals to optimize treatment outcomes.

An Updated Systematic Review and Meta-analysis of Duloxetine for Knee Osteoarthritis Pain

OBJECTIVE

We conducted the updated systematic review and meta-analysis of the best available quantitative and qualitative evidence to evaluate the effects and safety of duloxetine for the treatment of knee osteoarthritis (OA) pain.

METHODS

A comprehensive literature search used 3 English and 4 Chinese biomedical databases from inception through July 10, 2020. We included randomized controlled trials of duloxetine with intervention duration of 2 weeks or longer for knee OA. The primary outcome was pain intensity measured by Brief Pain Inventory and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcome measurements included 36-Item Short Form Health Survey, Patient's Global Impression of Improvement, Clinical Global Impressions of Severity, and adverse events (AEs). The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria. The review was registered in the PROSPERO (CRD 42020194072).

RESULTS

Six studies totaling 2059 patients met the eligibility criteria. Duloxetine had significant reductions in Brief Pain Inventory 24 hours average pain (mean difference [MD]=-0.74; 95% confidence interval [CI], -0.92 to -0.57; P<0.00001; I2=13%; 5 trials; 1695 patients); patient general activity (MD=-0.76; 95% CI, -0.96 to -0.56; P<0.00001; I2=0%; 5 trials; 1694 patients) WOMAC physical function subscale (MD=-4.22; 95% CI, -5.14 to -3.30; P<0.00001; I2=26%; 5 trials; 1986 patients); Patient's Global Impression of Improvement (MD=-0.48; 95% CI, -0.58 to -0.37; P<0.00001; I2=29%; 5 trials; 1741 patients); and Clinical Global Impressions of Severity (MD=-0.34; 95% CI, -0.44 to -0.24; P<0.00001; I2=0%; 4 trials; 1178 patients) compared with placebo control. However, no difference on WOMAC pain subscale (standard mean difference=-1.68; 95% CI, -3.45 to 0.08; P=0.06; I2=100%; 3 trials; 1104 patients) and in serious AEs (risk ratio=0.92; 95% CI, 0.40-2.11; P=0.84; I2=0%; 5 trials; 1762 patients) between duloxetine and placebo. Furthermore, duloxetine failed to show superior effects for improving the life quality and demonstrated more treatment-emergent AEs.

CONCLUSION

Duloxetine may be an effective treatment option for knee OA patients but further rigorously designed and well-controlled randomized trials are warranted.

Bidirectional relationship between physical health symptoms and depressive symptoms in the pre- and postpartum period

OBJECTIVE

To test the bidirectional relationships between physical health symptoms (PHS) and depressive symptoms (DS) as well as between the intensity of 'any pain' and DS in the pre- and postpartum period METHOD: Women (N = 615) completed the Edinburgh Postnatal Depression Scale, the Patients Health Questionnaire-15, and numerical pain rating scales when they were between 32 and 37 weeks of gestation, and subsequently one, three, and six months postpartum. We conducted two random intercept cross-lagged panel models (RI-CLPM) RESULTS: Both models presented excellent fits. The relationship between PHS and DS was bidirectional across all the data waves (χ²(9) = 6.610, p = .678, CFI = 1, TLI = 1, RMSEA = 0). The magnitude of the standardized cross-lagged regression coefficient was relatively similar from DS to PHS (raging between 0.081 and 0.171); and from PHS to DS (raging between 0.121 and 0.138). The relationship between 'any pain' intensity and DS was also bidirectional, but only during the postnatal period (χ²(9) =11.765, p = .227, CFI = 0.99, TLI = 0.98, RMSEA = 0.022). The magnitude of the standardized cross-lagged regression coefficient was higher from DS to 'any pain' intensity (raging between 0.214 and 0.216); than from 'any pain' intensity to DS (raging between 0.092 and 0.097).

CONCLUSIONS

Concurrently intervening over physical and mental health symptoms could promote women's perinatal health.

Association between disease progression and depression onset in persons with radiographic knee osteoarthritis

OBJECTIVES

Osteoarthritis (OA) disease progression may lead to deteriorating psychosocial function, but it is unclear what aspects of disease severity are related to the onset of depression. This study assessed which components of OA disease progression cumulatively contribute to depression onset in persons with radiographic knee OA.

METHODS

Osteoarthritis Initiative participants (n = 1651) with radiographic disease (Kellgren-Lawrence grade ≥2) in one or both knees and below the screening threshold for probable depression [Center for Epidemiological Studies Depression (CES-D) scale <16] at baseline were included. Disease severity was measured from baseline to the third annual follow-up visit using joint space width, 20-meter gait speed, and the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, each categorized into quintiles. Depression onset (CES-D ≥ 16) was assessed annually at four follow-up visits. Marginal structural models that account for time-dependent confounding and attrition evaluated the association between each time-varying disease severity measure and depression onset.

RESULTS

Each disease severity measure exhibited a non-linear relationship concerning the probability of depression onset, with the higher quintiles generally being associated with a larger risk. The highest quintile (relative to the lowest) of joint space width and gait speed were both significantly associated with depression onset. By contrast, none of the higher pain quintiles compared with the lowest were significantly associated with the onset of depression.

CONCLUSION

Faster disease progression as measured by either worsening structural severity or decreasing physical performance corresponds to an increased risk of depression among individuals with radiographic knee OA.

Effects of the Intervention "Reflective STRENGTH-Giving Dialogues" for Older Adults Living with Long-Term Pain: A Pilot Study

BACKGROUND

Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group.

METHODS

The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12).

RESULTS

The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p < 0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p < 0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention.

CONCLUSIONS

This pilot study supports STRENGTH's effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain.

Knee pain and future decline in higher-level functional competence in community-dwelling older Japanese: the Kurabuchi cohort study

BACKGROUND

The effect of knee osteoarthritis, which causes knee pain, on higher-level functional competence (HLFC) is not clear.

OBJECTIVE

To clarify the effect of knee pain on HLFC in older people.

DESIGN

Community-based prospective cohort study.

SETTING

Kurabuchi town, Gumma prefecture, Japan.

SUBJECTS

Community-dwelling individuals aged 65 and older.

METHODS

A total of 808 residents participated to the baseline examinations. The frequency of knee pain, degree of pain and functional impairment resulting from the pain were asked at baseline (2005-2006) via a self-administered questionnaire in Japanese based on an English version of the Western Ontario and McMaster Universities Osteoarthritis Index. Information on HLFC at baseline and during home visits were collected annually until 2014 with the Tokyo Metropolitan Institute of Gerontology Index of Competence. The association between baseline knee pain and HLFC decline was assessed with a Cox proportional hazards model.

RESULTS

Two factors, persistent knee pain and severe functional impairment caused by the pain, were significantly associated with future declines in total HLFC, with adjusted hazard ratios (95% confidence intervals) of 1.51 (1.08-2.11) and 1.49 (1.10-2.00). In analysis by subcategory, persistent knee pain had a significant adverse effect on participants' intellectual and social activities, and that severe physical functional impairment also had a significant impact on social activities.

CONCLUSIONS

The clear association of the frequency of knee pain and resultant functional impairment with future HLFC decline indicates that collecting information about these factors may be useful in identifying older people at high risk of future HLFC decline.

Depression Subtypes in Individuals With or at Risk for Symptomatic Knee Osteoarthritis

OBJECTIVE

The present study was undertaken to identify depression subtypes in individuals with or at risk for symptomatic knee osteoarthritis (OA) and to evaluate differences in pain and disability trajectories between groups.

METHODS

Participants (n = 4,486) were enrolled in the Osteoarthritis Initiative. Latent class analysis was applied to the 20-item Center for Epidemiologic Studies Depression Scale measured at baseline to identify groups with similar patterns of depressive symptoms, and subtypes were assigned using posterior probability estimates. The relationships between depression subtypes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and disability subscales were modeled over 4 years and stratified by baseline knee OA status (symptomatic [n = 1,626] or at risk [n = 2,860]).

RESULTS

Four subtypes were identified: asymptomatic (80.6%), catatonic (5.3%), anhedonic (10.6%), and melancholic (3.5%). Catatonic and anhedonic subtypes were differentiated by symptoms corresponding to psychomotor agitation and the inability to experience pleasure, respectively. The melancholic subtype expressed symptoms related to reduced energy and movement, anhedonia, and other somatic symptoms. Detectable mean differences in pain and disability compared to the asymptomatic group were observed for the anhedonic (1.5-2.3 WOMAC units) and melancholic (4.8-6.6 WOMAC units) subtypes, and associations were generally larger in individuals with symptomatic knee OA relative to those at risk.

CONCLUSION

Among individuals with or at risk for symptomatic knee OA, there is evidence of depression subtypes characterized by distinct clusters of depressive symptoms that have differential effects on reports of pain and disability over time. Our findings thus imply that depression interventions could be optimized by targeting the specific symptomology that these subtypes exhibit.

Association between severity of depressive symptoms and chronic knee pain in Korean adults aged over 50 years: a cross-sectional study using nationally representative data

OBJECTIVES

To identify the association between the presence and severity of depressive symptoms and those of chronic knee pain.

DESIGN

A retrospective cross-sectional study.

PARTICIPANTS

We used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2) performed in 2014. Overall, 7550 patients were included in the KNHANES VI-2.

OUTCOME MEASURES

Participants were asked whether they had chronic knee pain, and each answer was either 'yes' or 'no'. Patient Health Questionnaire-9 (PHQ-9) was used as a screening tool for depressive symptoms, and PHQ-9 scores of 10 or higher was classified as the depressed group. In total, 527 patients reported that they had pain in their knee, of whom 91 also had depressive symptoms.

RESULTS

The prevalence of chronic knee pain in the Korean population aged over 50 years was 19.8%. Multiple logistic regression was conducted after adjustment for sex, age, smoking, alcohol drinking, education level, household income, physical activity, sleep duration and comorbidity. The analysis revealed a significant association between depressive symptoms and chronic knee pain (adjusted OR=2.333, p<0.001). In contrast, the severity of depressive symptoms was linearly correlated with the intensity of chronic knee pain (p for trend <0.001). In participants with no chronic knee pain (Numerical Rating Scale; NRS=0) or mild chronic knee pain (NRS=1-4), the prevalence of moderate and severe depressive symptoms was 3.4% and 0.6%, respectively. However, in those with severe chronic knee pain (NRS=8-10), there was a higher prevalence of moderate and severe depressive symptoms (10.1% and 5.8%, respectively) (p<0.001).

CONCLUSIONS

A strong association was observed between the presence and severity of depressive symptoms and the presence of chronic knee pain. The association became stronger with higher levels of depressive symptoms, indicating a positive correlation between depressive symptoms severity and chronic knee pain.

Depression negatively affects patient-reported knee functional outcome after intraarticular hyaluronic acid injection among geriatric patients with knee osteoarthritis

PURPOSE

Intraarticular hyaluronic acid injection (IAHA) is a popular treatment for knee osteoarthritis (OA). This study investigates whether depression, anxiety, and pain affect self-reported knee function in geriatric OA people who have received IAHA.

METHODS

Through convenience sampling, 102 geriatric patients (mean age = 70.91 ± 7.19; 28 males) with knee OA who had undergone IAHA participated in this study. All participants self-reported depression using the Geriatric Depression Scale (GDS), anxiety using the State-Trait Anxiety Inventory (STAI), knee function using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee subjective knee evaluation form (IKDC), and pain severity using the Visual Analogue Scale (VAS). They completed the aforementioned questionnaires at baseline before injection and then again at 2-, 4-, and 6-month follow-ups.

RESULTS

Depression was significantly associated with IKDC, WOMAC physical function subscale, and total WOMAC scores. Anxiety was only significantly associated with the WOMAC pain subscale score. Pain severity was significantly associated with IKDC, WOMAC stiffness subscale, WOMAC physical function subscale, and total WOMAC scores.

CONCLUSION

Given that depression negatively affected patient-reported knee function among geriatric OA patients who had undergone IAHA, further attention should be paid to the depressive status of this population.

Genetic correlations between pain phenotypes and depression and neuroticism

Correlations between pain phenotypes and psychiatric traits such as depression and the personality trait of neuroticism are not fully understood. In this study, we estimated the genetic correlations of eight pain phenotypes (defined by the UK Biobank, n = 151,922–226,683) with depressive symptoms, major depressive disorders and neuroticism using the the cross-trait linkage disequilibrium score regression (LDSC) method integrated in the LD Hub. We also used the LDSC software to calculate the genetic correlations among pain phenotypes. All pain phenotypes, except hip pain and knee pain, had significant and positive genetic correlations with depressive symptoms, major depressive disorders and neuroticism. All pain phenotypes were heritable, with pain all over the body showing the highest heritability (h² = 0.31, standard error = 0.072). Many pain phenotypes had positive and significant genetic correlations with each other indicating shared genetic mechanisms. Our results suggest that pain, neuroticism and depression share partially overlapping genetic risk factors.

Path model of factors influencing health-related quality of life among older people with knee osteoarthritis

Chronic illness has a significant effect on quality of life, and a critical measure of health outcomes. Correlations between pain, depressive symptoms, fatigue, and physical function and their direct and indirect effects on quality of life were determined among 200 Thai older population with knee osteoarthritis using the Numeric Rating Scale, the Multidimensional Assessment of Fatigue, and the Thai Geriatric Depression Scale-15. Physical function was investigated by using the Timed Up and Go test. Path analysis revealed significant negative direct paths from pain, depressive symptoms, fatigue, and Timed Up and Go test results to quality of life. Pain, fatigue, and the Timed Up and Go test results had indirect effects on quality of life, while depressive symptoms had no indirect effect on quality of life. Increases in pain, depressive symptoms, fatigue, and Timed Up and Go test results were associated with reductions in quality of life. An understanding of the complex relationship among these variables is beneficial for designing an appropriate intervention for improving quality of life among older people with knee osteoarthritis.

Association between visual classification of kyphosis and future ADL decline in community-dwelling elderly people: the Kurabuchi study

This cohort study conducted in Japan showed that severe age-related kyphosis was visually detected. The visual assessment of kyphosis was associated with declines in ADL, suggesting that we can easily identify people at high risk to develop future ADL reduction in the community setting.

PURPOSE

Age-related kyphosis is related with declines in activities of daily living (ADL). Its conventional diagnosis has been made by orthopedic surgeons and trained examiners using specialized equipment such as X-rays. We investigated whether visual classification of kyphosis by laypersons accurately predicted future ADL decline.

METHODS

This study was part of the Kurabuchi Study, a cohort study of community-dwelling elderly Japanese. Between 2009 and 2010, three layperson raters used reference illustrations to classify 532 participants without ADL decline at study baseline into four categories. Other examiners used conventional methods to assess kyphosis in the same participants: curve ruler, Spinal Mouse, and the block method. ADL decline was defined as the development of dependence according to the Katz Index, admission to a nursing home, or certification of long-term care need.

RESULTS

Thirty-five of the participants (6.6%) were classified with the most severe degree of kyphosis at baseline by visual assessment. Interrater agreement was high (Kappa = 0.73) for the most severe group. During 4.5 years of follow-up, 106 participants (19.9%) showed ADL decline. On the basis of visual assessment, the adjusted risk ratio for ADL decline among the participants with the most severe kyphosis was 2.6 (95% CI: 1.4-4.6). Assessments of kyphosis made with the Spinal Mouse also accurately predicted ADL decline.

CONCLUSIONS

Visual assessment of kyphosis predicted future declines in ADL in this study. Since our method requires no special tools or training, it may be useful for identifying those at high risk of ADL decline.

Worsen depression after viscosupplementation treatment for geriatric people with knee osteoarthritis?

Background/objective: Knee osteoarthritis (OA) in older people may result in psychological impairment, including anxiety and depression. This study investigates the effect of intraarticular hyaluronic acid injection (IAHA) on geriatric patients with OA. Method: A total of 102 geriatric patients with knee OA undergoing IAHA were prospectively enrolled in this study. Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and Visual Analogue Scale (VAS) for pain were recorded. All outcomes were measured at baseline before injection and during two, four, and six month follow-ups. Results: IAHA had a significant short-term effect, relieving pain at the two month follow-up, but the effect was weaker at the four month follow-up. Both IKDC and WOMAC scores were significantly improved at the two month follow-up. Viscosupplementation did not improve STAI. GDS exhibited significant deterioration at the four month follow-up. Conclusions: Although IAHA for the treatment of OA provided short-term efficiency, it had no effects on anxiety and increased depression of geriatric people. Health education should be provided with caution before viscosupplementation treatment to manage expectations of the efficacy of treatment for geriatric OA patients.